entire issue - The Royal New Zealand College of General Practitioners

More documents

Recommendations

Info

ORIGINAL SCIENTIFIC PAPERS short report Table 1. Basic demographic data Age, mean, range Education Marital status Employment All patients n=46 29.8 [18–42] Diagnosis made n=36 29.9 [20–43] No diagnosis n=10 29.6 [18–40] College or advanced degree 31 23 8 High school 11 9 2 No high school 4 4 0 Single 36 27 9 Unwed couple 3 2 1 Married 5 5 0 Separated/divorced 2 2 0 Employed outside home 32 25 7 Student 7 5 2 Not employed outside home 7 6 1 Contraception ‡ OCP/ring 12 10 2 IUD 2 2 0 None 6 6 0 Abstinence 4 1 3 Condoms 18 13 5 Depo-Provera 1 1 0 Sterilisation 1 1 0 No response 2 2 0 Annual income ‡ >$40K–80K 11 8 3
ORIGINAL SCIENTIFIC PAPErS short report basis of office tests (pH, microscopy, whiff test). Four additional diagnoses were made based on culture: one candida, one chlamydia and two herpes simplex (HSV). Taking into account both office diagnoses and culture, 15 women had BV alone, 13 women had candida alone, two women had trichomonas alone and two women had HSV. Four women had dual diagnoses: two with BV and candida, one with BV and chlamydia, and one with trichomonas and candida. No woman was diagnosed with a non-infectious cause of vaginitis (contact dermatitis or allergic reactions). Ten patients (22%) were undiagnosed. Psychological distress and diagnosis Eleven women had diagnoses suggested from scoring the PHQ survey. Seven women had a single diagnosis: three had somatisation, two had minor depression and one each had panic and anxiety. Three women had dual diagnoses; one patient each had somatisation associated with either minor depression, major depression or panic disorder. One woman was diagnosed with minor depression, panic disorder, and anxiety. PHQ diagnoses were not more common in women without a medical diagnosis (Table 2). Symptom resolution We were able to contact 45 patients for follow-up at one week’s time (one lost to follow-up) and 33 patients at two weeks’ time (13 lost to followup). At one week 21 (47%) patients had complete resolution of symptoms, 20 (44%) had partial resolution of symptoms and four (9%) reported no change in symptoms. At two weeks 22 (67%) were completely better, 10 (30%) were a little better and only one patient was no better. No patient reported that symptoms were worse at either time. Symptoms decreased markedly at the one week follow-up and decreased further at two weeks; these differences were statistically significant and occurred in both the diagnosis and non-diagnosis group. Differences in clinical resolution and symptom scores were not statistically different between the diagnosis and non-diagnosis groups. Table 2. Diagnoses and association with psychological distress Diagnosis Based on PHQ scoring We considered that three points on the Vaginal Complaints Scale represented a meaningful clinical difference. To have 80% power for detecting a difference of three using a two-tailed test with alpha = 0.05, and a correlation of zero between the baseline and follow-up measure would require 91 people in each group. Discussion Women with a diagnosis (n=36) In this pilot study we failed to find increased levels of psychosocial distress in women with undiagnosed vaginal symptoms when compared to those who did have a diagnosis. Both groups of patients experienced prompt symptomatic relief of their symptoms. Thus, in terms of psychological distress and symptom resolution, patients in our study who went undiagnosed seemed indistinguishable from patients with a medical diagnosis. Our rate of non-diagnosis (22%) compares favourably to that reported in the medical literature as do our range of diagnoses. Our study is, however, limited by the small sample size, the convenience nature of the sample, relatively poor follow-up at two weeks (74%), and the fact that the PHQ is primarily a screening tool. The simplest explanation of our findings is that women without a medical diagnosis are reacting appropriately to bodily changes in the same way as women with an identified cause. This would suggest that there may be unidentified infectious pathogens or processes that are causing their symptoms. Another explanation is that psychosocial stress is causing them to over-react to normal bodily functions but that the levels of stress are equivalent to those of persons with symptoms caused by a pathogen. It may be that the PHQ Women without a diagnosis (n=10) Somatisation 5 (14 %) 1 (10%) Depression Depressive syndrome 4 (11%) 0 Major depressive disorder 1 (3%) 0 Panic syndrome 3 (8%) 0 Anxiety syndrome 2 (5%) 0 Women with any disorder 10 (24%) 1 (10%) Note: No significant differences noted in any comparison using Fisher’s exact test VOLUME 2 • NUMBER 2 • JUNE 2010 J OURNAL OF PRIMARY HEALTH CARE 153
Page 1:
VOLUME 2 • NUMBER 2 • JUNE 2010
Page 4 and 5:
EDITORIALs from the editor Populati
Page 6 and 7:
ORIGINAL SCIENTIFIC PAPERS quantita
Page 8 and 9:
Page 10 and 11:
Page 12 and 13:
Page 14 and 15:
Page 16 and 17: ORIGINAL SCIENTIFIC PAPERS quantita
Page 44 and 45: ORIGINAL SCIENTIFIC PAPERS quaLitat
Page 64 and 65: ORIGINAL SCIENTIFIC PAPERS short re
Page 68 and 69: ORIGINAL SCIENTIFIC PAPERS short re
Page 70 and 71: BACK TO BACK those who do not. 2 Th
Page 72 and 73: BACK TO BACK ADHD, 3 the progressio
Page 74 and 75: continuing professional development
Page 80 and 81: ethics Ethics 101 column. 6 The ton
Page 82 and 83: LETTERS TO THE EDITOR PSA screening
Page 84 and 85: BOOK REVIEW Interpreting in New Zea
Page 86 and 87: POLICY STATEMENT FOR AUTHORS Second
Page 88 and 89: RESEARCH GEMS Gems of New Zealand P
Page 90: about the journal of primary health
show all

entire issue - The Royal New Zealand College of General Practitioners

Create successful ePaper yourself

Delete template?

Save as template?